The impact of nicotine addiction in terms of morbidity, mortality, and economic costs to society is enormous. Tobacco kills more than 430,000 U.S. citizens each year, more than alcohol, cocaine, heroin, homicide, suicide, car accidents, fire, and AIDS combined. Tobacco use is the leading preventable cause of death in the United States.
Economically, an estimated $80 billion of total U.S. health care costs each year is attributable to smoking. However, this cost is well below the total cost to society because it does not include burn care from smoking-related fires, perinatal care for low-birth-weight infants of mothers who smoke, and medical care costs associated with disease caused by secondhand smoke. Taken together, the direct and indirect costs of smoking are estimated at $138 billion per year.
Nicotine is one of thousands of chemicals found in the smoke from tobacco products such as cigarettes, cigars, pipes and smokeless tobacco products, such as snuff and chewing tobacco. Nicotine is one of the most frequently used addictive drugs. First identified in the early 1800s, nicotine is the primary component in tobacco that acts on the brain, and has been shown to have a number of complex and sometimes unpredictable effects on the brain and the body.
Addiction is characterized by compulsive drug-seeking and use, even in the face of negative health consequences. The majority of cigarette smokers identify tobacco as harmful and express a desire to reduce or stop using it, but less than 7 percent of the nearly 35 million of those who make a serious attempt to quit each year succeed. Several factors also serve as determinants for first use and, ultimately, addiction, such as its high level of availability, the small number of legal and social consequences of tobacco use, and the sophisticated marketing and advertising methods used by tobacco companies.
Research has shown how nicotine increases the levels of dopamine in the brain circuitry that regulates feelings of pleasure, the so-called reward pathways, and this is of primary importance to its addictive nature. Nicotine's pharmacokinetic properties have been found also to enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation. The acute effects of nicotine dissipate in a few minutes, causing the smoker to continue dosing frequently throughout the day to maintain the drug's pleasurable effects and prevent withdrawal.